You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
- Ensure all prior authorization requests are reviewed and completed accurately and timely
- Assist with prior authorizations and determinations for appropriate drug products for complex or escalated requests
- Research and develop new cost reduction, pricing, quality improvement and revenue enhancement activities
- Ensure that clinical pharmacy services are in compliance with laws and regulations
- Review any provider or physician complaints, recommend solutions to address the issues and update senior management as needed
- Develop and implement policies and procedures related to clinical pharmacy services
- Oversee the analysis of pharmacy cost of care and trends and recommend changes for improvements
- Oversee the development and implementation of medication therapy management programs. Evaluate program performance, recommend changes and ensure successful implementation of changes
Education/Experience: Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy. 4+ years of mail order, retail, hospital or managed care pharmacy experience or pharmacy residency program experience. Management experience preferred.
Licensure/Certification: Current state's pharmacy license.
Preferred Qualifications:
Preferred candidates will have experience supporting a Prior Authorization or Decision Tree team, preferably within Medical Pharmacy. Candidates should be proficient in Microsoft applications including Visio, Excel, and Word, and be available to work a schedule that may begin as early as 9:30 AM EST.
Pay Range: $107,700.00 - $199,300.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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